Ear: Mastoidectomy & tympanoplasty

Mastoidectomy and Tympanoplasty

Indications

Reconstruction of the ear to a safe, dry state (may include hearing restoration).

As part of other procedures (e.g. cochlear implantation).

There are many variations on the procedure depending on the extent of disease and the surgeon’s preferences. If you are unsure, ask. Types of tympanoplasty range from 1 to 5; a Type 1 tympanoplasty (repair of tympanic membrane perforation alone) is also known as a myringoplasty and is covered separately.

Procedure

The disease can be approached via the ear canal (permeatal), or via an endaural incision or a post-auricular incision. This will be determined by the operating surgeon.

A drill is used to open the mastoid air cells and access the attic (superior middle ear cavity). Disease is removed from the middle ear cleft. This may entail removal of some of the ossicles, or drilling out of the mastoid air cells. A cavity is sometimes opened into the ear canal by taking down the posterior canal wall. Alternatively, the middle ear can also be accessed by raising the tympanic membrane, with preservation of the posterior canal wall (combined-approach tympanoplasty).

Length of procedure

Variable, from 1-3 hours or more depending on disease extent.

Complications

Pain

Bleeding (rare)

Infection Also quite rare. If BIPP (a bright yellow antiseptic) ribbon is used, this causes a yellow-brown discharge which can be mistaken for infection.

Residual disease There is always a chance of leaving some disease in the ear. This may depend on the approach used – combined-approach tympanoplasty may require a second-look procedure (this may decrease with the advent of advanced MRI techniques).

Recurrence Due to ongoing middle ear disease.

Hearing loss A degree of conductive hearing loss may be inevitable due to the removal of diseased ossicles. Reconstruction may have limited effect. There is also a small possibility of complete sensorineural hearing loss.

Facial palsy A facial nerve monitor is generally used. This complication is rare (<1%). A temporary palsy due to local anaesthetic or contusion/heating of the nerve is more likely than permanent palsy due to transection.

Taste disturbance The surgeon tries to preserve the chorda tympani. It is occasionally unavoidably damaged, or may already be damaged by disease. Patients may complain of a metallic taste postoperatively – this often improves over time.

Tinnitus Usually temporary but rarely long-lasting.

Dizziness Again, usually a temporary postoperative effect.

Scar

Post-operative management

Patients are frequently able to go home the same day. There may be a pressure dressing over the ear – check the op note for when this can be removed. The ear canal dressing is usually removed in clinic two weeks later.

Examine the patient for facial weakness prior to discharge. If there is any, inform the operating surgeon immediately.